The candidate, Dr. Guadalupe Garcia-Tsao, is Associate Professor in the Department of Internal Medicine at the Yale University School of Medicine. She has devoted her career to patient-oriented research (POR) in the area of cirrhosis and in complications. She has been involved in a wide range of POR, from descriptive studies to multicenter randomized clinical trials. Her studies in the area of varices, variceal hemorrhage, ascites and spontaneous bacterial peritonitis have made significant contributions to the management of patients with cirrhosis, the sixth leading cause of death in the United States in individuals between the ages of 25 and 65, the productive years of life. She is recognized as a clinical research in the area of portal hypertension as attested by invitations to chair abstract selection committees and to serve as session moderator at important scientific meetings, as well as invitations to write editorials, review articles and to become panel member at international consensus panels. Ascites is one of the main complications of cirrhosis and portal hypertension and Dr. Garcia-Tsao's short tem goals are to focus on this complication. One of these goals is to implement a randomized trial comparing the transjugular intrahepatic porto-systemic shunt with serial large-volume paracenteses in the treatment of patients with refractory ascites. This multicenter trial, partially funded by a VA Merit Review, will analyze not only differences in efficacy but also differences in quality of life and cost, and the results can potentially change current standards of care for patients with cirrhosis. R. Garcia-Tsao's long-term career goals are to continue to perform POR focused on prophylactic therapy and identification of prognostic factors in chronic liver disease as well as furthering her training in health services research. Dr. Garcia-Tsao has devoted a great deal of effort toward mentoring beginning clinical investigators in POR, especially in her capacity as co-Director of the Liver Center's Clinical Core. Yale University is one of the major teaching and research institutions of the United States and as such has well-established research and educational resources that will continue to be utilized by the candidate. The proposed award will allow her to carry out her research and mentoring objectives successful so that she can continue to make significant contributions in the field of cirrhosis and its complications.